Michael Dennis Bryan, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

J1503 Issued in TX

Practice address

660 W Southlake Blvd
Suite 100
Southlake, TX 76092-6003

Phone

(817) 416-9731

Fax

(817) 416-9751

NPI assigned

Feb 15, 2006

Last updated

Jul 9, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Michael D. Bryan, MD

  • Otolaryngology Physician
  • Southlake, TX
  • NPI 1811148802
  NPD (past) Authorized official
• Amy K. Mettman, M.D., P.a.

  • Otolaryngology Physician
  • Southlake, TX
  • NPI 1386939262
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341792000000",
    "number": "1043284128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 W SOUTHLAKE BLVD",
            "address_2": "SUITE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926003",
            "telephone_number": "817-416-9731",
            "fax_number": "817-416-9751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 W SOUTHLAKE BLVD",
            "address_2": "SUITE 100",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760926003",
            "telephone_number": "817-416-9731",
            "fax_number": "817-416-9751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "MICHAEL",
        "middle_name": "DENNIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2012-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TX",
            "license": "J1503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0052ET",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5675166",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113601203",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Darnell Brown, D.C
• David Scott Brown, M.D.
• Jeremy Randall Brown, D.C.
• Molly Brown
• Kennedy Jo Brumbelow
• Morgan Cecily Bryan, NP-C
• Btdi JV LLP (Touchstone Imaging Southlake)
• Joanne Buchanan
• Chelsea Morgan Buchta, DPT
• Amanda C Buck, M.S.CCC-SLP

• Otolaryngology Physician in Southlake, TX
• Providers in Southlake, TX by specialty
• Otolaryngology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.